Secondary Logo

Journal Logo

Institutional members access full text with Ovid®


Kumawat, Devesh MD; Venkatesh, Pradeep MD; Brar, Anand S. MBBS; Sahay, Pranita MD; Kumar, Vinod MS; Chandra, Parijat MD; Chawla, Rohan MD

doi: 10.1097/IAE.0000000000002448

Purpose: To study the etiology, clinical features, management options, and visual prognosis in various types of atypical macular holes (MHs).

Methods: A review of the literature was performed, which focused on the etiopathogenesis of atypical or secondary MHs, their differentiating clinical features, management strategies, and varied clinical outcomes. Idiopathic or age-related, myopic, and traumatic MHs were excluded.

Results: Atypical or secondary MHs arise out of concurrent ocular pathologies (dystrophy, degeneration, or infections) and laser/surgery. The contributing factors may be similar to those responsible for idiopathic or typical MHs, i.e., tangential or anteroposterior vitreofoveal traction or cystoid degeneration. The management is either observation or treatment of the underlying cause. The prognosis depends on the background pathology, duration of disease, and baseline visual acuity governed by the size of MH and morphologic health of underlying RPE and photoreceptors. The closer the morphology of atypical MH is to that of an idiopathic MH, the better the surgical outcome is.

Conclusion: With the advancements in retinal imaging, atypical MHs are now more frequently recognized. With increasing understanding of the underlying disease processes, and improvement in investigations and surgical treatment, management of atypical MHs may improve in the future.

The insight into pathophysiology, prognosis, and surgical outcomes of atypical macular holes is limited. This review article provides readers with meaningful domains of atypical macular holes, along with their prognosis and the rationale management approach needed in such cases.

Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Reprint requests: Devesh Kumawat, MD, Room No 485, Fourth Floor, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India; e-mail:

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.